A series of lectures by Dr. Barry Raphael on Airway-focused orthodontics from 2013. Chapter 9: A summary of key concepts in Airway-focused Orthodontics

1. Airway Orthodontics
A lecture series prepared by
Dr. Barry Raphael
Of the
Raphael Center for Integrative Orthodontics
Clifton, NJ.
www.alignmine.com
www.myobracenj.com
“A String of Pearls” - 2013
1Thursday, June 6, 13

2. •Animations are not included in this archive and may
affect the meaning or intent of the slide
•As the information in these presentations is
constantly evolving, please consider the date of creation
when reviewing the material.
2Thursday, June 6, 13

3. A String of Pearls
“The mind is like a
parachute:
it’s best when it’s open”
3Thursday, June 6, 13

4. Pearl #1
Malocclusion is a SYMPTOM of a greater imbalance
•Malocclusion is a relatively new phenomenon
•Since it takes over 20,000 years for a gene change to
become incorporated into the genome, malocclusion
cannot be genetic
•Malocclusion is due to a mismatch of our geneotype with
our environment
•Malocclusion is one of many CNCDC
4Thursday, June 6, 13

5. Pearl #2
•The conditions to which the face must adapt begin at birth
(and even before).
•These conditions have a cumulative effect that will likely result
in some DEVIATION from ideal.
•90% of these Effects will be permanent by Age 12
•“Orthodontic Treatment” is just one more condition that
affects adaptation
•Even when we do “nothing”, the face is still being
“treated”.
Treatment must focus on the problem when it starts
One Phase treatment is Early Treatment by Neglect
5Thursday, June 6, 13

6. Pearl #3
•The Maxilla is usually RETRUSIVE
•The mandible adapts to this environment
•It may be retruded more than the maxilla due to
muscle pull or constricted space (Class II)
•It may be as retruded as the maxilla, with dental
compensations for lack of space (Class I)
•It may grow normally, and leave the maxilla behind
(Class III)
•But the MAXILLARY DYSMORPHIA is the same for all
Deviations
Angle Classification is Misleading
6Thursday, June 6, 13

7. Pearl #4
Retraction and Extrusion aggravate the situation
• Open mouth posture is THE critical element in the
formation of the maxilla.
• Maxillary changes (dysmorphia) are in all three
dimensions of space
•Transverse deficiency
• Sagitall retrusion
•Vertical excess
• Currently, there are no mainstream protocols to reverse
this condition
7Thursday, June 6, 13

8. Pearl #5
•Maxillary Dysmorphia encroaches on the nasopharyngeal airway
•The airway is related to breathing and sleep disorders.
• Hampering adaptation predisposes to airway issues.
•This may include conditions which:
• Prevent the airway from growing properly (ie: open mouth posture)
• Prevent the airway from being expanded properly (ie: distalization
mechanics)
• Perpetuates damage already occured (ie: constriction mechanics,
untreated soft tissue dysfunction
All treatment, in the final analysis, is about the AIRWAY.
8Thursday, June 6, 13

9. Conclusions: The pharyngeal
airway size became narrower after
the treatment. Extraction of four
premolars with retraction of
incisors did affect velopharyngeal,
glossopharyngeal,
hypopharyngeal, and hyoid
position in bimaxillary protrusive
adult patients.
9Thursday, June 6, 13

10. Pearl #6
•Malocclusion is a Solution to provide Equilibrium and
Homeostasis
10Thursday, June 6, 13

11. Nature’s Solution:
Adaptation (Malocclusion)
11Thursday, June 6, 13

12. Pearl #6
•Malocclusion is a Solution to provide Equilibrium and
Homeostasis
•If we “rebalance” the occlusion, we disturb the equilibrium
12Thursday, June 6, 13

13. Orthodontic’s Solution
Retainer
13Thursday, June 6, 13

14. Pearl #6
•Malocclusion is a Solution to provide Equilibrium and
Homeostasis
•If we “rebalance” the occlusion, we disturb the equilibrium
•There are always unintended consequences, even if subclinical
Relapse
Occlusal Wear
Occlusal Trauma
Bruxism
Joint Derangement
Referred Pain
Sleep Apnea
Assorted physical ailments
14Thursday, June 6, 13

15. Pearl #6
•Malocclusion is a Solution to provide Equilibrium and Homeostasis
•If we “rebalance” the occlusion, we disturb the equilibrium
•There are always unintended consequences, even if subclinical...
•...Unless we make compensations elsewhere (respiratory,
musculo-skeletal, neurological, circulatory systems)
15Thursday, June 6, 13

16. MyoFunctional Ortho
Teeth and Occlusion
Tongue, MM,TMJ
Cranial,Cervical,Posture
Whole Body (resp,
circ, musc-skel, etc)
16Thursday, June 6, 13

17. Pearl #6
•Malocclusion is a Solution to provide Equilibrium and Homeostasis
•If we “rebalance” the occlusion, we disturb the equilibrium
•There are always unintended consequences, even if subclinical...
•...Unless we make compensations elsewhere (respiratory,
musculo-skeletal, neurological, circulatory systems)
We must broaden the scope of our concern beyond teeth
17Thursday, June 6, 13

18. The Orthodontic
Uncertainty Principle
Is ortho a cosmetic service ?
Is ortho a health service?
18Thursday, June 6, 13

19. The Orthodontic
Uncertainty Principle
Is ortho a corrective service ?
Is ortho a curative service?
19Thursday, June 6, 13

20. The Orthodontic
Uncertainty Principle
Is ortho a mechanical service ?
Is ortho a behavioral service?
20Thursday, June 6, 13

21. The Orthodontic
Uncertainty Principle
Is ortho a mechanical service ?
Is ortho a behavioral service?
Can it be both?
(That depends on your point of view…)
21Thursday, June 6, 13

22. Orthodontics in the
21st Century
Conventional
Orthodontics
Airway
Orthodontics
Genetic
Tooth-Focused
Dental Model: Perfection
Esthetics Primary
Treating Symptoms
Airway Ignorant
Adaptation
Muscle-Focused
Medical Model: Better
Esthetics Secondary
Treating Causes
Airway Concious
22Thursday, June 6, 13